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Orthognathic surgery involving the mandible can lead to remodelling of the temporomandibular joint (TMJ). Cone beam computed tomography (CBCT) provides an easily accessible three-dimensional (3D) approach to study this entity. A systematic review of the literature was performed with the aim of identifying condylar remodelling analysis protocols using CBCT-derived 3D models. The search yielded 10 eligible studies. The systematic review identified three pillars of a condylar remodelling analysis protocol that were retrievable from each of the included studies: (1) registration, (2) segmentation, and (3) analysis. The studies lacked consensus on how these pillars should be transferred to their respective protocol. Through critical assessment, criteria for a universal condylar remodelling analysis are suggested: (1) performance of a regional voxel-based registration of baseline and postoperative CBCT scans using an anatomical region not prone to postoperative changes, (2) application of a (semi-)automated 3D segmentation algorithm, (3) performance of a combination of both volumetric and surface-based 3D condylar analysis, and (4) extensive validation of each step of the protocol. The homogenization of condylar remodelling analysis protocols and their incorporation into virtual planning software suites raises the potential for the inclusion of larger numbers of patients in future prospective studies in order to gain evidence-based data. ispartof: INTERNATIONAL JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY vol:49 issue:2 pages:207-217 ispartof: location:Denmark status: published

Previous reports have suggested a possible association between tumour necrosis factor alpha (TNF-α) inhibitors, used in the treatment of immune-mediated inflammatory diseases, and medication-related osteonecrosis of the jaw (MRONJ). However, a comprehensive assessment of the frequency and severity of MRONJ caused by these agents is lacking. The aim of this cohort study was to investigate the occurrence of MRONJ in a population of patients with inflammatory bowel disease (IBD) treated with TNF-α inhibitors at a tertiary care medical centre. A total of 2701 IBD patients under current or former treatment with TNF-α inhibitors were identified in an IBD registry covering the period 1994-2018. These patients were cross-matched with all patients diagnosed with MRONJ. This resulted in three patients with a definite diagnosis of MRONJ, without concomitant treatment with bisphosphonates. All three patients required surgical treatment with sequestrectomy. Mucosal healing occurred at 4-15 months and one patient developed recurrence. In conclusion, this study identified and described anti-TNF-α-related MRONJ occurring in a large cohort of IBD patients, and reported the severity and treatment strategies used. ispartof: INTERNATIONAL JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY vol:49 issue:3 pages:317-324 ispartof: location:Denmark status: published

Various free flap transfers can be associated to reconstruct a defect after resections in the head and neck region. The use of these flaps can be synchronous (one-stage surgery) or metachronous (two-stage surgery) in order to correct or improve secondary residual deformities. A two-stage use of free flaps, first with an osteocutaneous scapular flap and second with a fascial radial forearm flap, is reported after total maxillectomy. The osteocutaneous scapular flap was used to restore function (swallowing, chewing, speech and cheek projection) and the radial forearm flap to improve esthetic facial morphology. Minor ancillary procedures were subsequently necessary to achieve the final result (brow lift, tarsal straightening and facial lift).

Incomplete excision of a pleomorphic adenoma exposes to a high risk of recurrence and tumor spread, making secondary surgery more difficult or a malignant transformation with a poor vital prognosis likely. Three histological types of pleomorphic adenomas can be observed when the tumor undergoes a transformation, namely the carcinoma ex-pleomorphic adenoma, the true malignant mixed tumor and the benign metastasizing mixed tumour.

The knowledge of the neurological diseases is an essential factor to establish a relation between the practitioner and the child or the handicapped adult. The authors suggest to describe some pathologies with a particular attention for the keywords to realize a concerted management.